A Comparison of Remifentanil versus Fentanyl as an Adjuvant to Propofol Anesthesia for Ureteroscopic Lithotripsy

Min, Jinhye; Kim, Young Ho; Chae, Young Keun; Lee, Woo Kyung; Choi, Sun soon; Chai, Hong Seok; Choi, Young Soon

Abstract

BACKGROUND: Remifentanil is a new member of fentanyl family and a short-acting, esterase-metabolized opioid.This study compared the perioperative characteristics of a remifentanil infusion with those of fentanyl bolus administration as an adjuvant to propofol infusion for the anesthetic management of patients undergoing ureteroscopic lithotripsy.
METHODS
Eighty patients were randomly assigned to receive either remifentanil target controlled infusion (R group, effect-site concentration of 4.0 ng/ml for induction followed by 2.0 ng/ml) or fentanyl bolus (F group, 2.0microgram/kg before induction).All patients received propofol infusion as the part of the induction and maintenance.We investigated recovery profiles, adverse events and the ease of insertion of laryngeal mask airway (LMA) between the two groups.Heart rate (HR) and mean blood pressure (MBP) were also compared at baseline (T0), loss of consciousness (T1), insertion of LMA (T2), beginning and end of operation (T3, T4) and removal of LMA (T5).
RESULTS
The time from the end of anesthesia to spontaneous respiration, eye opening and LMA removal were significantly shorter for patients receiving remifentanil than for those receiving fentanyl.HR at T3 and T4 were lower in the R group than in the F group.Aldrete recovery score, time to discharge from recovery ward, the ease of insertion of the LMA, MAP and adverse events did not differ significantly between the two groups.
CONCLUSIONS
Target controlled infusion of remifentanil combined with propofol can significantly shorten the early recovery time than fentanyl bolus administration without increasing adverse events in patients undergoing ureteroscopic lithotripsy.